Invasive ventilatory devices
-Oral pharyngeal airway
-Nasal pharyngeal airway
-Endotracheal tube
Endotracheal tube
-Indications: upper airway obstruction, aspiration pneumonia, secretions
-Below level of vocal cord
Passy Muir valve
Attached to a trachestomy tube that allows for vocalization
Complications of tracheostomy
-Primary hemorrhage, late hemorrhage
-Pneumothorax, hemothorax
-Surgical emphysema
-Tracheaesophageal fistula (5-7 days)
Intermittent mandatory ventilation
-Controlled breath, non weaning
-Sets rate regardless of pt effort (12 = 12 breaths per min)
Synchronized intermittent mandatory/spontaneous
-Weaning mode
-Augments inspiratory phase with a preset amount of pressure
Pt breathes mostly IND, ventilator only supplies 2 breaths/min
Assist control
-Weaning
-Machine delivers positive pressure at a rate established by pt effort
Pt breathes mostly IND, ventilator only supplies 2 breaths/min
Neurally adjusted ventilator assist
-Electrode into NG tube
-Stops at diaphragm level
-Senses when diaphragm contracts
Goal of ventilated patients
Return of spontaneous breathing
Weaning criteria
-Resolution of initial event that cause ARF
-Maximized status
-Afebrile
-Improving/stable chest x ray
-Secretions manageable
-Specific respiratory parameters
Weaning parameters
-Adequate respiration (ABG analysis)
-Hemodynamic stability (BP)
-Ambu bag, suctioning
-Strength
Signs of distress during weaning
-Tachypnea > 30 breaths/min
-HTN
-Tachycardia
-Increased use of accessory mm
-Agitation
-Respiratory acidosis
When to stop/modify tx
-O2 < 88
-Increased accessory mm use
-RR > 20
-Hypotension
-Abnormal increase in HR
Effective mobilization
-Premedicated
-After chest tube removed, hold therapy until radiography rules out pneumothorax
How does a ventilator work?
-Positive pressure expands chest
-Chest wall recoils = exhalation